Fiber optic medical tool

ABSTRACT

A medical tool, preferably taking the form of a speculum, wherein fiber optics are carried by the distal ends of members which extend into a body orifice to provide visualization and illumination of the body area interior of the orifice. Manipulative access is provided to the area within the orifice between the inner surfaces of the spread apart members of the speculum-type tool which extends into the orifice.

i l'\/ v Q Q m XR 39664 9330 T J l J nited States rate ,664,330 Deutsch May 23, 1972 54 FIBER OPTIC MEDICAL TOOL FOREIGN PATENTS OR APPLICATIONS [72] Inventor: Harold L. Deutsch, New York, N.Y.' 1,126,036 7/1956 France ..128/3 1,511,373 12/1967 France ..128/6 [22] Flled- 1969 26,752 1907 Great Britain... ..128/13 21 APPLNO; 57 3 25,040 1912 Great Britain... ..l28/18 964,567 7/1964 Great Britain.... 128/6 605,136 5/1960 Italy ..128/18 [52] U.S.Cl ..l28/18, 128/342 51 1111. C1. I ..A61b 1/06 OTHER PUBLICATIONS [58] Field Of Search ..l28/39, ll, 13, Chas Truax, Greene & C0, Catalogue 1893, 6th Edition p,

128/16, 18, 22, 23, 20, 341, 342, 345, 303.11 1,230, (Copy in Gr. 335,128/3) [56] References Cited Primary Examiner--Kyle L. Howell I Attorney-Flynn & Frishauf UNITED STATES PATENTS 57 ABSTRACT 2,592,190 4/1952 Rubens et a1, ..128/6 1 1,222,478 4/1917 Sheaff ..128/18 A medical tool, prfiferably taking the form of a p m, 2,932,294 4/1960 Fourestier et a1 ..128/6 wherein fiber Optics are cam'ed by the distal ends of members 2 975 785 3/1961 Sheldon 128/6 which exfencl mio 'a body orifice to provide visualization and 3,132,646 5/l964 He I I '3 "128/6 illumination of the body area interior of the orifice. Manipula- 3186300 6/1965 B X tive access is provided to the area within the orifice between 90286 6 1 65 i 128 6 the inner surfaces of the spread apart members of the specu- 3,1 9 to es lunflype toblwhichextendsimothe orifica 3,324,850 6/1967 Gunmng et al. 3,435,820 4/1969 Taub ..128/11 17 Claims, 7 Drawing Figures Fler v; ewm

1 Hum bu n4 IQ;

I B, u a Id! We we! PATENTEUMMBIQR A v 3.664330 sum 1 [If 3 7 INVENTOR.

' v Haro/dLDeufsb/z Fly/7n 8 Fr/shauf ATTORNEYS '2 PAIENTmmzamrz 3.664.330 I sum 2 M3 INVENTOR.

BY Haro/dLfleufsc/z F/ynn 8 F/v'shauf ATTORNEYS 2 FIBER OPTIC MEDICAL TOOL i This invention relates to a fiber optic medical tool and more particularly to a fiber optic tool which enables simultaneous manipulative access, illumination and visualization within a body orifice.

A major problem confronting the medical profession is performing operations on hard to reach internal areas of the human body. In many cases, the patient must be inconveniently located and the surgeon must work in uncomfortable positions, thereby impairing efficiency during the operation. In certain cases, in order to perform operations on various internal portions of the human skull it is necessary to perform substantial preliminary surgery in order to gain access to the area which is to be operated on. For example, many operations performed on the sinuses and the inner cavities of the nasal passages require the surgical lifting of the nose or of substantial portions of the upper cheek area. Also, many operations being performed on the eyes and related muscles and tissues, require substantial cutting away of other healthy portions of the skull in order to gain access to the area requiring repair or excision. Moreover, many relatively minor surgical operations require the lifting of the skull and of the brain in order to gain access to the desired internal portions of the skull. All of these above-described procedures substantially increase the dangers involved in the operation and subject the patient to great trauma. Also, the recuperative period is increased.

Not only are the above difficulties present in gaining access to areas within a natural body orifice, but difficulties also arise in diagnosing and treating various internal portions of the body which are not in communication with a natural body orifice. For example, in the case of acute appendicitis, it would be of great value to be able to diagnose and treat the patient through a smaller body opening than as presently required. At present, it is necessary to diagnose acute appendicitis externally (with an approximately 15 percent chance of error) and to then remove the appendix (vermiform process) through a relativelylarge incision, thus requiring an approximately days recuperative period for the patient. It would be greatly desirable if a smaller incision could be made and the condition diagnosed and treated through a small incision. If the diagnosis indicates an inflamed appendix, it would be advantageous to be able to operate and remove the appendix through the same small incision through which the diagnosis was made. In this manner, more accurate diagnosis of conditions, such as appendicitis, could be made, and the recuperative period for the patient could be reduced to approximately 2 days.

Therefore, the main object of the present invention is to provide a device which will not only allow manipulative access to various internal portions of the body, but which also will provide illumination and visualization of the area Within the body so that a desired operation or manipulation may be performed without the necessity of performing substantial surgery on unrelated healthy portions of the body to gain access thereto.

A further object ofthe present invention is to provide such a device which will enable microscopic manipulations and operations to be more easily performed on various internal portions ofthe body.

-Another object of this invention is to provide such a tool which may be used in conjunction with natural, or surgically made, body orifices.

SUMMARY OF THE INVENTION In accordance with the present invention, a medical tool for simultaneously providing manipulative access, illumination and visualization within a body orifice includes a device having a pair of substantially parallel elongated members having distal ends adapted to extend into the body orifice to provide manipulative access to the body area interior of the orifice. Further provided is fiber optic lighting and visualizing means, at least a portion thereof being carried by the distal ends of the device extending into the body orifice, for illuminating and providing a visual representation of the area interior of the orifice to enable the simultaneous manipulative access, illumination and visualization within the body orifice.

By virtue of the present invention, it is possible to perform a BRIEF DESCRIPTION OF THE DRAWING FIG. 1 illustrates an embodiment of the present invention which provides manipulative access, illumination and visualization of the interior of the nasal passage;

FIG. 2 illustrates a second embodiment of the invention having a different shape to enable access, illumination and visualization of a different area within the nasal passage;

FIG. 3 illustrates a still further embodiment of the present invention for use in gaining access to the nasal passage;

FIG. 4 illustrates in more detail an example of the optical portion of the device of the present invention;

FIG. 5 illustrates another embodiment of the optical portion of the present invention;

FIG. 6 illustrates another embodiment of the present invention which provides manipulative access, illumination and visualization of a body area interior of a body orifice, and

FIG. 7 illustrates another modification of the present invention.

FIG. 1 illustrates an embodiment of the present invention for use in gaining access to and examining the interior of the nasal passages. The medical tool 1 of the present invention includes a pair of substantially parallel members 2 and 3 which are pivotally connected together at their proximal end portions by means of a screw or other equivalent pivoting device. Members 2 and 3 are provided with projecting (or extending) portions 5 and 6, respectively, having distal ends which are adapted to extend into a body orifice and with outwardly bulging portions 7 and 8 respectively. In this embodiment projecting portions 5 and 6 are integral with outwardly bulging portions 7 and 8, respectively. Further provided is a sleeve arrangement 9 which is slideable in the direction of the arrow 50 and which operates in conjunction with bulging portions 7 and 8 for spreading apart and releasing the projecting portions 5 and 6. As the sleeve 9 is moved in the upward direction, portions 5 and 6 are caused to spread apart and visa versa. The operation ofsuch a sleeve arrangement in conjunction with outwardly bulging portions 5 and 6 should be apparent to one ordinarily skilled in the art.

Connected at the lower end of the sleeve arrangement 9 is a flexible fiber optic bundle 10 which transmits light therethrough. The fiber optic bundle I0 is connected to the tool 1 by means of connection 11. To the other end of fiber optic bundle 10 is connected a viewing device 12, such as a binocular microscope or a stereo microscope, the designs of which are well-known in the art. Both microscopes give a three-dimensional view. More particularly, devices which are suitable for use as the viewing device 12 of the present invention are disclosed in U.S. Pat. No. 3, I 86,300, issued to H. Littmann on June I, 1965 and in U.S. Pat. No. 3,417,745, issued to E. E. Sheldon on Dec. 24, 1968. Other equivalent devices or other desired viewing devices may be used. The viewing device l2 is secured in place by means of a clamping arrangement 13 in order to free the hands of the operator.

At the distal ends of the projecting portions 5 and 6 of tool I, are optical devices 14 and 15, respectively. Carried by either or both of the members 2 and 3, are fiber optic rods or bundles which are optically connected with the fiber bundle at connection 11. The optical devices 14 and 15 are optically connected to the other ends of the fiber optic bundles or rods carried by members 2 and 3. If desired, optics may only be carried by one of members 2 and 3. In this case only one of optical devices 14 and 15 are required.

The fiber optics carried by members 2 and 3 are preferably embedded within the walls of members 2 and 3, or members 2 and 3 are hollow and the fiber optics are within the hollow space, so as not to provide any protruding or projecting surfaces.

FIGS. 2 and 3 show alternate embodiments of the tool of FIG. 1 for use in gaining access to different body areas.

In FIGS. 1-3 the tool of the present invention takes the general fonn ofa speculum.

Referring to FIG. 4, there is shown a portion of member 2 constructed in accordance with the present invention. At the end of protruding portion 5 of member 2 is a lens 18 which is optically coupled with a fiber optic bundle 19 carried by member 2. In this embodiment, the member 2 is hollow, and the optics are embedded within the walls, but it should be clear that member 2 could be solid with the optics being embedded therein. Also mounted at the end of the protruding portion 5 of member 2 is a transparent window 20 which is optically coupled with a fiber optic bundle 21. At the other end 22 of the fiber optic bundle 21, is located a source of light 23 which provides illumination to a body area via fiber optic bundle 21 and transparent window 20. The other end 24 of fiber optic bundle 19 is connected with fiber optic bundle 10 through connection 11, the remote end of fiber optic bundle 10 being connected to the viewing device 12.

In the embodiment of FIG. 4, all of the optics required for the system are carried by one of the members 2 and 3. To obtain three dimensional viewing, an identical set of optics may additionally be carried by the other of members 2 and 3. The two sets of optics are then coupled to a three dimensional viewing device. Three dimensional viewing devices are wellknown in the art and a detailed description thereof is not included herein.

An alternative arrangement to that shown in FIG. 4 is to locate the illuminating source 23 within the member 2 to illuminate a body area. In this alternative arrangement, the additional fiber optic bundle 21 is not required. A still further altcrnativc is to place the illuminating source 23 within the other of members 2 and 3 to illuminate the desired area. In this case, one ofthe members 2 and 3 carries the illuminating source and the other carries the visualizing optics which in cludes lens 18 and fiber optic bundle 19.

The arrangement whereby the light source 23 is located outside ofthe members 2 and 3 (as in FIG. 4) has an advantage in that the light source may be easily varied or changed without requiring dismantling of the medical tool of the present invention.

In certain instances, the tool of the present invention will be utilized for examination and manipulation of areas of the body wherein tissues and/or internal organs will tend to cover the lens 18 and thereby obscure the operators vision. For this type of usage, the embodiment illustrated in FIG. 5 is useful.

In FIG. 5, the illumination and visualization is achieved via the inside surfaces of the tool 1, that is, the surfaces between the projecting portions 5 and 6 which define the access area provided by the medical tool.

In FIG. 5, the projecting portion 5 of member 2 includes a light source 24 which is coupled to a power source (not shown) by means of electrical leads 25. Behind the light source 24 is a reflector 26 which may take the form of a mirror. Mounted on the inner wall 27 of projecting portion Sis a transparent window 28. Reflector 26 reflects and directs the light emitted from light source 24 through the window 28 to illuminate a predetermined area of the body internal to the cavity into which the tool is extending. In this embodiment, the reflector 26 directs the light in a beam having a spreading angle of a.

Projecting portion 6 of the member 3 carries a fiber optic bundle 29 which is optically coupled to a lens 30. The lens 30 is optically coupled to a prism 31 having a predetermined angle of reflection. Mounted on the inner wall 32 of projecting portion 6 is a transparent window 33 through which the desired area of the body is visualized. The prism directs the image of the portion of the body to be visualized on the distal end-face of the fiber optic bundle 29 via the lens 30. The optical system within member 3 is capable of viewing the angle [3. The angles a and ,8 are chosen so that the illuminated area can be properly visualized.

In the embodiment of FIG. 5, as the members 5 and 6 are spread apart (for example, as in FIG. 1 by moving the sleeve 9 in the upward direction to press against outwardly bulging portions 7 and 8), the body tissues internal of the cavity will press only against the outer and end portions of the projecting portions 5 and 6. The inner surfaces 27 and 32 of projecting portions 5 and 6, which are spread apart, remain free of obstruction and access is gained to the internal portions of the body cavity through the space defined between the inner surfaces 27 and 32 of projecting portions 5 and 6. The visualization and illumination windows 33 and 28, respectively, are mounted on inner surfaces 27 and 32 which remain unobstructed, thereby enabling good visualization of the internal body area.

It should be clear that other alternative optical arrangements may be used in the embodiment of FIG. 5. For example, the light source 24 and reflector 26 may be replaced by a fiber optic bundle (such as the bundle 21 of FIG. 4) and an external light source (such as the light source 23 of FIG. 4). Further, an optical system similar to the arrangement carried by projecting portion 6 of FIG. 5 and the illuminating system carried by projecting portion 6 of FIG. 5 can be combined into a single structure which can be mounted within one of the portions 2 and 3 of the medical tool of the present invention. An example ofsuch a combined structural arrangement is disclosed in US. Pat. No. 2,987,960 issued to G. .l. Sheldon on June 13, l96l. Other equivalent optical arrangements can be used. A further modification of the system shown in FIG. 5, would be to embed the various optical devices into a tool having solid portions 2 and 3 rather than hollow portions 2 and 3 as shown in FIG. 5. Various other modifications can be made to the systems disclosed herein by those ordinarily skilled in the art within the spirit of the present invention.

In use, the projecting or extending portions 5 and 6 oftool l are inserted into a body orifice such as nasal orifice 17 of FIG. 1, and extend within a body cavity 16 of FIG. 1. Then, the projecting portions 5 and 6 are spread apart by moving the sleeve 9 in the upward direction to effectively press inwardly on the outwardly bulging portions 7 and 8. Depending upon the particular area of the body being operated on, the sleeve 9 is moved upwardly until the desired spreading between members 5 and 6 is achieved. This substantially widens the orifice 17. Manipulative access to the area inside cavity 16 is gained by the space defined between the inner surfaces of spread apart projecting members 5 and 6 (such as inner surfaces 27 and 32 of FIG. 5). Illumination is achieved by means of the light source contained in either or both of members 5 and 6 (such as sources 23 of FIG. 4 or 24 of FIG. 5) and visualization of the area is achieved by means of the fiber optics carried by either or both of members 2 and 3 (such as fiber optic bundle 19 of FIG. 4 or 29 of FIG. 5 and their associated optics) and viewing device 12.

In this manner, using the tool of the present invention, the desired areas within the body cavity are illuminated and visualized, and manipulative access is provided in the space defined by the spread apart projecting members 5 and 6. I-Ieretofore, this has not been possible.

FIG. 6 illustrates yet another embodiment of the present invention. In this embodiment, the two members 2 and 3 of FIGS. l-5 are replaced by a single cylindrically-shaped member 40 shown in a partially broken away view in FIG. 6. In this embodiment, a lens 41 is embedded in a wall of the cylindrical member 40 and is optically coupled to a fiber optic bundle 42 which is also embedded in a wall of cylindrical member 40. The lens 41 is embedded in the end wall and is used to view the desired area of the body. Also embedded in the end wall of cylindrical member 40 is a transparent window 43 which is optically coupled with a light source 44. Light source 44 is also embedded in a wall of cylindrical member 40 and is coupled to a power source (not shown) by means of lead wires 45 also embedded in cylindrical member 40. It should be clear that the light source 44 could be replaced by a separate fiber optic bundle and external light source as shown in FIG. 4. Moreover, two or more sets of optical systems, such as shown in FIG. 6, can be used with a single cylinder 40, depending upon the system application.

In the embodiment of FIG. 6, the fiber optic bundle 42 ex tends through the wall of the cylindrical member 40 and is coupled to the fiber optic bundle (such as shown in FIG. 1) by means of an optical coupling device 46. Alternatively, the fiber optic bundle 42 may be integral with the fiber optic bundle 10. The output of fiber optic bundle 10 is connected to a viewing device, such as viewing device 12 of FIG. 1.

In use, the front portion 47 of cylindrical member 40 is inserted into a body orifice and extends within a body cavity. The orifice may be large enough to accept the cylindrical member 47 or the orifice may be spread open by other means and cylindrical member 40 inserted therein. The outer walls of cylindrical member 40 will keep the orifice in its widened position and access is gained to the interior portions of the cavity through the interior of hollow cylindrical member 40.

Illumination and visualization of the desired area within the cavity is achieved by means of the optical system comprising light source 44, fiber optic bundle 42 and lens 41. When the system of FIG. 6 is used in portions of the body wherein the lens and illumination system tend to be obscured by the body organs, the optical system may be imbedded in the walls of cylinder 40 in a manner similar to that shown in FIG. 5. That is, a prism is provided in conjunction with lens 41 and a transparent window is located on the inner surface of the walls of cylindrical member 40 to provide visualization from the interior portion of the cylinder. The illumination means may be similar to that shown in FIG. 5. This modified arrangement may be utilized with a cylindrical member 40 having solid walls or with a cylindrical member 40 having hollow walls, such as shown in FIG. 5.

The arrangement of FIG. 6 is not as versatile as the arrangement of FIGS. 1-4, but for certain applications will provide adequate results. For example, the apparatus of FIG. 6 may be useful for examining and manipulating body portions through orifices which are easily enlarged by other means to accept the cylindrical member 40 of FIG. 6. The tools of FIGS. l-5 are more useful in applications wherein it is necessary to widen the orifice with the tool of the present invention.

FIG. 7 illustrates yet another embodiment of the invention wherein projecting (or extending) portions 5 and 6 of members 2 and 3 are each outwardly curved to define a greater access area to the internal body portions. The lens system and illumination system may operate via the ends 14 and 15 of members 2 and 3, respectively, or may operate via transparent windows in the interior walls of portions 5 and 6 in a manner similar to that shown in FIG. 5.

It should be clear that the tool 1 of the invention could be basically constructed of stainless steel or other suitable nontransparent material. Alternatively, a suitable transparent material may be used, thereby eliminating the requirement for transparent windows, such as window of FIG. 4 and windows 28 and 33 of FIG. 5. For economy, the tool 1 is preferably made of a sterilizable material.

The medical devices of this invention have a wide range of uses, including examination of and operation upon a variety of body portions. By way of illustration, a speculum 1 shown in FIG. 2, can be employed in the examination of and, if necessary, as an aid in operating upon the cribriform of the ethmoid 34. This is a portion of the roof of the nasal cavity 16 and cribriform.

separates the nasal cavity from the frontal lobe of the brain. When the cribriform 34 is damaged, fluid from the brain seeps through the cribriform into the nasal cavity 16 and loss of such fluid often leads to (1) meningitis, (2) brain abcess, (3) convulsions, (4) coma, and' (5) death. To repair the cribriform, or even to examine a cribriform suspected of damage, it has been heretofore necessary to open the calvarium of the skull and lift the frontal lobe of the brain in order to gain access to the cribriform from the top. In so gaining access, it is generally necessary to excise the olfactory nerves on and adjacent to the cribriform. Thus, while repair of the cribriform can be accomplished successfully and the patient saved, the patient generally survives with no olfactory sense. Loss of sight is a further complication that should be avoided in this operation.

The medical tool illustrated in FIG. 2, which takes the form ofa speculum 1 can be inserted in nasal chamber 16 and members 5 and 6 can be spread apart to distend the chamber 16 to provide an area of up to about percent larger than normal. The speculum 1 can be passed into nasal chamber 16 and the optics thereof is positioned to provide a view of cribriform 34. Should the latter require repair, an appropriate surgical tool such as a curved stapes knife (not shown) can be inserted within the area between members 5 and 6', and repair can be accomplished readily. Thus, there is no need to open the skull and move the frontal lobe of the brain to gain access to the A speculum such as illustrated in FIG. 1 can also be used in gaining access to the middle ear (tympanic cavity). For example, the speculum 1 can be inserted into the ear and the portions 5 and 6 thereof can be separated in order to distend the ear canal (external acoustic meatus). The optics carried by the speculum 1 is positioned to provide a desirable view of the middle ear and the appropriate suitable repair can be accomplished, if necessary, by using middle ear instruments which are inserted within the area bounded by the extending arms 5 and 6 of the speculum 1.

A speculum of the character illustrated in FIG. 5 can be employed in examination and repair of the anal canal and areas in communication therewith. The speculum can be inserted within the anal canal and can be maneuvered therewithin so as to provide a visualization of a suspect member, such as the internal sphincter (levator ani). Repair can be accomplished by inserting a suitable tool (e.g., wire hook snare for excisional biopsy of a polyp or polyps or biopsy forceps) within the area bounded by portions 5 and 6 of the speculum within tha anal canal. Since the body parts within the anal canal are spongy and resilient in nature, the optical configurations of FIGS. 14 would not provide satisfactory visualization of the desired body areas. The optics would tend to be obscured by the surrounding body members. Thus, in this case, the tool of FIG. 5 with the recessed optics in the inner walls of projecting portions 5 and 6 will provide the-best results.

Still another portion of the body which can be examined and repaired with the aid of the medical tools of this invention, is the vaginal area. A speculum 1 having recessed optics, such as shown in FIG. 5, can be inserted within the vaginal orifice and positioned such that the optics thereof provides a suitable view of the cervix, for example. The cervix can be viewed for any morbidity. A suspect portion of the cervix can be viewed carefully by adjusting the magnification of the lens and of the viewing device, such as a microscope, associated with the fiber optics system of the speculum. Fluid adjacent the'cervix can be removed therefrom by inserting a suitable pipette or swab within the area bounded by the extending members of the speculum within the vagina, and then tested. Similarly, a curette can be inserted within the same area and the particular suspected portion of the cervix can be scraped to obtain a tissue sample for examination. If repair or excision of the suspected area is determined to be essential, such repair or excision can be accomplished with the speculum in place and the appropriate medical tools being employed with the said area.

Another use of the medical tools of this invention is in conjunction with body orifices made by surgery. For example, a

surgical opening of about 6-8 mms. in length can be made in the abdominal wall in the proximity of the appendix (vermiform process). A device such as illustrated by FIG. can be inserted through the opening and the optics thereof can be positioned to provide a satisfactory view of the appendix. If the appendix is free from morbidity, the device can be withdrawn and the opening closed by appropriate suture. If the appendix is morbid, the appendix can be removed by conventional appendectomy technique with a suitable cutting instrument being inserted within the area bounded by the portions 5 and 6 of the speculum 1 within the abdominal opening. it is to be noted that it is advantageous to provide the illumination and visualization through the inner walls of one or both arms 5 and 6 of the speculum 1 in order to avoid obscuring or covering of the optics by the cecum, ileum or adjacent body members.

By utilizing suitable optics and viewing devices (such as viewing device 12) the tool of the present invention enables microscopic operations to be simply performed with less danger to the patient. Depending upon the application, optics may be included in one or both of members 2 and 3 and variable magnification and variable incident angles may be provided.

Further, the cylindrical member 40 of FIG. 6 may be any conveniently shaped elongated hollow body, such as a tube having an eliptical, square or other desired cross-section.

iclaim:

l. A medical tool for simultaneously providing manipulative access, illumination and visualization within a body orifice comprising:

first and second substantially parallel elongated members movable with respect to each other and both having distal ends which are adapted to extend into said body orifice and to enlarge said body orifice to provide manipulative access to a body area interior of said orifice;

means coupled to the proximal ends of said first and second members and including means laterally offset with respect to the longitudinal axes of said first and second members for moving apart said first and second members while maintaining said members substantially parallel to each other to enlarge said orifice, thereby providing an unimpeded opening for manipulative access from outside said orifice to the interior of said orifice;

lighting means, at least a portion thereof being carried by at least one of said first and second members and extending to the distal end of said at least one member, for illuminating said body area proximate said distal end;

fiber optic visualizing means, at least a portion thereof being carried by at least one of said first and second members and extending to the distal end of said at least one member, for providing an image of at least a portion of said body area proximate said distal end; and

optical means adapted to be located exterior of said orifice and coupled to said fiber optic visualizing means to provide, exterior of said orifice, a visual representation of said image of said body area proximate the distal ends of said members interior of said enlarged orifice, thereby enabling simultaneous manipulative access, illumination and visualization within said body orifice.

2. A medical tool according to claim 1 wherein at least a portion of said fiber optic visualizing means carried by said at least one member is recessed within the distal end of said at least one member and provides said image from an inner wall M A, nonhuman!- of the distal end ofsaid at least one member which defines said body access area.

3. A medical tool according to claim 2 wherein said at least one member carrying said fiber optic visualizing means includes a transparent window therein in communication wfith said fiber optic visualizing means, said image being provided through said transparent window.

4. A medical tool according to claim 1 wherein at least a portion of said lighting means carried by said at least one member is recessed within the distal end of said at least one of said first and second members for illuminating said body area from an inner wall of the distal end ofsaid at least one member which defines said body access area.

5. A medical tool according to claim 4 wherein said at least one member carrying said fiber optic visualizing means includes a transparent window therein in communication with said fiber optic visualizing means, said image being provided through said transparent window.

6. A medical tool according to claim 1 wherein said fiber optic visualizing means includes a lens optically coupled to the end ofa fiber optic bundle, said lens and at least a portion of the bundle being adapted to be carried by the distal end of said at least one member within said orifice.

7. A medical tool according to claim 6 wherein said laterally offset means includes pivot means pivotally connecting said first and second members together.

8. A medical tool according to claim 23 wherein said lighting means includes a fiber optic bundle carried by said at least one of said first and second members, and a light source being coupled to said fiber optic bundle.

9. A medical tool according to claim 1 wherein said laterally offset means includes pivot means pivotally connecting said first and second members together.

10. A medical tool according to claim 9 wherein said first and second members are pivotally connected at the same pivot point.

11. A medical tool according to claim 9 wherein said means for moving apart said members includes respective operating members angularly extending from said first and second members, said laterally offset means pivotally connecting said operating members together to thereby provide said unimpeded opening for manipulative access.

12. A medical tool according to claim I wherein said fiber optic visualizing means is carried by said first movable member and said lighting means is carried by said second movable member.

13. A medical tool according to claim 1 wherein said first and second members are outwardly curved with respect to each other, said access being provided to said body area interior of said orifice through the area enclosed by the inner walls ofsaid spread-apart outwardly curved members.

14. A medical tool according to claim 1 wherein said fiber optic visualizing and said lighting means are carried by said first movable member.

15. A medical tool according to claim 1 wherein each of said first and second movable members carries said fiber optic visualizing means.

16. A medical tool according to claim 17 wherein said optical means includes a three dimensional viewing device coupled to said fiber optic visualizing means.

17. A medical tool according to claim 1 wherein said optical means includes a microscope viewing device coupled to said fiber optic visualizing means. 

1. A medical tool for simultaneously providing manipulative access, illumination and visualization within a body orifice comprising: first and second substantially parallel elongated members movable with respect to each other and both having distal ends which are adapted to extend into said body orifice and to enlarge said body orifice to provide manipulative access to a body area interior of said orifice; means coupled to the proximal ends of said first and second members and including means laterally offset with respect to the longitudinal axes of said first and second members for moving apart said first and second members while maintaining said members substantially parallel to each other to enlarge said orifice, thereby providing an unimpeded opening for manipulative access from outside said orifice to the interior of said orifice; lighting means, at least a portion thereof being carried by at least one of said first and second members and extending to the distal end of said at least one member, for illuminating said body area proximate said distal end; fiber optic visualizing means, at least a portion thereof being carried by at least one of said first and second members and extending to the distal end of said at least one member, for providing an image of at least a portion of said body area proximate said distal end; and optical means adapted to be located exterior of said orifice and coupled to said fiber optic visualizing means to provide, exterior of said orifice, a visual representation of said image of said body area proximate the distal ends of said members interior of said enlarged orifice, thereby enabling simultaneous manipulative access, illumination and visualization within said body orifice.
 2. A medical tool according to claim 1 wherein at least a portion of said fiber optic visualizing means carried by said at least one member is recessed within the distal end of said at least one member and provides said image from an inner wall of the distal end of said at least one member which defines said body access area.
 3. A medical tool according to claim 2 wherein said at least one member carrying said fiber optic visualizing means includes a transparent window therein in communication with said fiber optic visualizing means, said image being provided through said transparent window.
 4. A medical tool according to claim 1 wherein at least a portion of said lighting means carried by said at least one member is recessed within the distal end of said at least one of said first and second members for illuminating said body area from an inner wall of the distal end of said at least one member which defines said body access area.
 5. A medical tool according to claim 4 wherein said at least one member carrying said fiber optic visualizing means includes a transparent window therein in communication with said fiber optic visualizing means, said image being provided through said transparent window.
 6. A medical tool according to claim 1 wherein said fiber optic visualizing means includes a lens optically coupled to the end of a fiber optic bundle, said lens and at least a portion of the bundle being adapted to be carried by the distal end of said at least one member within said orifice.
 7. A medical tool according to claim 6 wherein said laterally offset means includes pivot means pivotally connecting said first and second members together.
 8. A medical tool according to claim 23 wherein said lighting means includes a fiber optic bundle carried by said at least one of said first and second members, and a light source being coupled to said fiber optic bundle.
 9. A medical tool according to claim 1 wherein said laterally offset means inclUdes pivot means pivotally connecting said first and second members together.
 10. A medical tool according to claim 9 wherein said first and second members are pivotally connected at the same pivot point.
 11. A medical tool according to claim 9 wherein said means for moving apart said members includes respective operating members angularly extending from said first and second members, said laterally offset means pivotally connecting said operating members together to thereby provide said unimpeded opening for manipulative access.
 12. A medical tool according to claim 1 wherein said fiber optic visualizing means is carried by said first movable member and said lighting means is carried by said second movable member.
 13. A medical tool according to claim 1 wherein said first and second members are outwardly curved with respect to each other, said access being provided to said body area interior of said orifice through the area enclosed by the inner walls of said spread-apart outwardly curved members.
 14. A medical tool according to claim 1 wherein said fiber optic visualizing and said lighting means are carried by said first movable member.
 15. A medical tool according to claim 1 wherein each of said first and second movable members carries said fiber optic visualizing means.
 16. A medical tool according to claim 17 wherein said optical means includes a three dimensional viewing device coupled to said fiber optic visualizing means.
 17. A medical tool according to claim 1 wherein said optical means includes a microscope viewing device coupled to said fiber optic visualizing means. 